Maternity care project
CSH is partnering with the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM) and the Sustainable Healthcare Coalition (SHC) to deliver the project “Taking collective action to deliver low carbon, equitable maternity care”.
Maternity care – sometimes called antenatal care or pregnancy care – is a large umbrella term that encompasses the wide range of clinical, medical and social interventions that accompany pregnancy and childbirth.
This year-long SBRI project aims to engage the multi-disciplinary maternity community through studying the maternity care pathways, highlighting carbon and health inequity hotspots, supporting maternity teams to run QI projects to tackle these hotspots, and bringing the whole community together to discuss how the findings can influence future maternity care.
How does global warming affect maternity care?
The impact of global warming not only on maternity care services but the health and wellbeing of the parent and the child is well documented. With increasing heatwaves, adverse weather events, air pollution and more all having significant negative effects.
Research into climate change and the potential effects on maternal and pregnancy outcomes has identified a clear link between negative maternal and pregnancy outcomes and a lack of food, safe drinking water and proper sanitation caused by climate induced migration; increased frequency of extreme weather events; changing patterns of disease and morbidity, especially with emerging tropical diseases such as Zika; and direct heat exposure through climate change. It is clear that the consequences of climate change for pregnant women and the unborn child can be substantial.
The lack of sustainability in maternity care
Despite the fact maternity care is highlighted as one of the key clinical challenges in the Core20Plus5 equity strategy – an NHS England approach to reduce health inequalities at a national and system level – there is still a lack of focus on maternity care in discussions around increasing sustainable models of care, and there are still huge inequities in care delivery and experience.
The NHS itself has taken great strides to reduce its carbon footprint, dropping emissions by 30% since 2010, exceeding its commitments under the climate change act, but despite this, still has a long way to go. The carbon footprint of all healthcare in general is high, accounting for 4.4% of all emissions globally, but maternity care itself is a significant sector within that. The maternity care pathway is often high volume, caesarean sections alone for example are one of the most common surgeries carried out across the NHS. Entonox, a pain relieving gas mixture administered during childbirth accounts for 2/3rds of Nitrous Oxide emissions. Despite this clear data there has been no comprehensive carbon footprinting of maternity services.
Taking collective action to deliver low carbon, equitable maternity care
It is clear that inequity in healthcare is a key barrier to achieving the EU’s 2030 Agenda for Sustainable Development and the SDGs, and the inequity in women’s maternal health is a significant issue. According to the MBRRACE statistics, between 2019 and 2021 – the latest statistics available at the time of writing and statistically unchanged from the 2018 to 2019 period – women of Black ethnic backgrounds were four times more likely than white women to die in childbirth, and Asian women were almost twice as likely. This is compounded by socio-economic factors, with women living in the most economically deprived areas having a maternal mortality rate two-and-a-half times higher than women living in the least deprived areas.
One of the biggest disparities of maternity provision is in continuity of care. Seeing the same midwife and developing a supportive, trusting relationship between the service user and the care giver is widely known to bring about better outcomes for both mother and baby, so much so that the NHS Long Term Plan sees continuity of care as a priority and states that 75% of women from Black, Asian and other ethnic minorities and women from the most deprived areas should receive continuity of care by 2024. Unfortunately this target has never come close to being met thanks in large part to reported causes such as suboptimal staffing levels, which is just one of the many reasons that inequity in maternity care needs to be tackled as a matter of urgency.
But how exactly will making maternity care more sustainable help to reduce inequity of care? This is just one of the key questions this project aims to answer.
What will this project achieve?
To tackle inequity and the lack of sustainability in maternity care, a long term, multidisciplinary approach is needed. Alongside SBRI Healthcare, the Centre for Sustainable Healthcare is collaborating with the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the Sustainable Healthcare Coalition to deliver the project “Taking collective action to deliver low carbon, equitable maternity care”.
But more than that, this study aims to engage expert advisors from obstetrics and midwifery as well as a panel organised by the RCOG of those with lived experiences of maternity care and their advocates. This year-long project aims to engage the multi-disciplinary maternity community through studying the various maternity care pathways, highlighting carbon and health inequity hotspots, supporting maternity teams to run QI projects to tackle these hotspots, and bringing the whole community together to discuss how the findings can influence future maternity care.
The project includes;
- Mapping the maternity pathways to identify carbon and inequity hotspots
- Agreeing target areas where changes could affect carbon and equity at the same time
- A Green Maternity Challenge where maternity teams from across the UK co-design Sustainability in Quality Improvement (SusQI) projects with our lived-experience group to test changes in situ
- Events to feed back the learning to the maternity community including industry partners
How is the Centre of Sustainable Healthcare helping to reduce carbon and inequity in maternity care?
In collaboration with our partners and wider members of the multidisciplinary professions, the Centre for Sustainable Healthcare will manage the year long project as well as bringing our carbon footprinting and practical SusQI expertise to help ensure the project delivers its potential benefits. We will help align net zero and equity actions with clinical and patient priorities in an effort to ultimately improve patient outcomes and experiences, and reduce health inequities.
Service-user and clinical engagement will increase understanding of maternity sustainability and equity hotspots, and increase engagement with both in practice, and by modelling cross-disciplinary working and service-user involvement we will promote a culture of integration, team working and co-design on the ground and improve the experience of maternity service users.
Environmental, social and economic benefits will be quantified at project level and scaled to national level providing robust measurement, and industry partners will be aware of target areas for innovation, and clinical guidance, education and national quality work can embed Net Zero and equity from the learning and outputs of this project.
But equally as important, we are showcasing the power of community action, and already we are confirming that the maternity community is full of energy, determination, ideas and strong networks and this positivity is driving the project forward and helping to grow the Women’s Health Sustainability Network, bringing increased knowledge and action on delivering high value, sustainable, equitable care.
Project timeline
Launch and events
July 2024
The launch of the project will coincide with a series of events on the CSH Networks. These events will engage with the maternity community including clinical professionals and those with lived experiences, and will identify key target areas within the maternity care pathway that could be explored.
Recruitment and workshops
July – October 2024
This phase of the project will concentrate on recruiting specialist teams within the maternity care community who will use a series of workshops to come up with individual projects for the Maternity Care Challenge 2024.
Projects
October 2024 – January 2025
Individual teams will run their SusQI projects as part of the Green Maternity Challenge 2024.
Showcase Event
March 2025
Teams will showcase and present their work to a judging panel and wider audience, The results of each of these projects will be used to improve the sustainability and equity of maternity care service pathways.
Maternity events
CSH held a series of network events to identify key target areas within the maternity care pathway that could be explored. By focusing Quality Improvement and service re-design projects around these target areas, maternity care can become more equitable and sustainable. These target areas overlap and many projects will tackle several at the same time.For all improvement work the outcome and experience of the people using the services is key. These should be maintained or improved in particular for people who are underserved by the status quo.
- Valuing people’s time:
Streamlining services and systems to avoid waste.
Examples: Tackling delayed discharge, efficient scheduling of appointments, decreasing travel to appointments
Example links to environmental impact: Appointments, hospital bed stays and travel all contribute to carbon emissions and environmental harm.
- Supporting informed choices:
Providing relevant information and support so that people can successfully access/implement the choices that are best for them and the planet.
Examples: Linking into local voluntary provision, access to pain relief, better access to translation services, culturally relevant support, being explicit about sustainability choices e.g. bounty packs
Example links to environmental impact: Appropriate and personalised care can reduce inefficiency in systems and use of resources that are of low-value to women and birthing people – which can save carbon and waste.
- Listening to women:
Reducing waste and improving outcomes by involving people in their own care, co-designing services and utilising third sector support.
Examples: More say for people in how and where they access care, processes that value the voices of women
Example links to environmental impact: Personalised care can be more efficient, reducing healthcare activity that is of low value to women and birthing people. Leveraging third sector support can reduce the need for hospital-based care by providing community-based solutions, which typically have a smaller environmental impact compared to traditional healthcare settings.
- Access and experience for people who experience worse maternity outcomes:
Focusing resource and/or re-designing systems to cater for those that the system has underserved before.
Examples: Improvement of services for people living in deprived communities, black and asian women and young mothers and birthing people
Example links to environmental impact: Reducing health inequalities leads to better outcomes for wider populations which long term reduces healthcare activity and resource use which contribute to carbon emissions
- Complex pregnancies:
Improved systems for those with additional care needs or complications.
Examples: hypertension pathway improvements, new ways of monitoring, reducing travel to appointments
Example links to environmental impact: Optimising health by reducing complications and streamlining care for complications reduces inefficiencies in healthcare activity and resource use (e.g. appointments, medicines and avoidable emergency care) which contribute to carbon emissions.
- Infant feeding:
Meeting the unmet need of those who want to breastfeed but lack appropriate support.
Examples: improved systems for supporting women in their feeding choices including peer support and culturally relevant nutritional support
Example links to environmental impact: Streamlined support and improved feeding outcomes reduces need for additional appointments and resources which contribute to carbon emissions and waste.
- Pelvic health and continence:
Tackling the long-lasting effects of poor continence following childbirth.
Examples: Promotion of ante-natal pelvic health guidance, access to specialist services, improvement to perineal tear care
Example links to environmental impact: Improving continence may prevent life-long need for continence products and associated care which contribute to carbon emissions and waste.
Green Maternity Challenge 2024
As part of this larger maternity project, the green maternity challenge will be delivered by CSH in partnership with the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM) and the Sustainable Healthcare Coalition (SHC).
In the Green Maternity Challenge, six clinical teams in the UK will be selected to receive training and mentoring from CSH to develop, plan, run, and measure the impact of a sustainable quality improvement (SusQI) project. Projects will focus on identified target areas for reducing environmental harm and health inequalities.
To read more about the green maternity challenge and it’s impact, please visit our dedicated project page.
How can you help make maternity care more sustainable?
Join our Women’s Health Sustainability Network and make your voice count. This new and growing online hub will be our primary forum for the project and members run monthly events and share up to date research and sustainability news.
Through this project, we will show that maternity care can be more sustainable and more equitable, and by working in collaboration with each other, health professionals and service users can work toward more environmentally sustainable changes during pregnancy, birth and postpartum which helps to reduce the carbon footprint having a baby brings. Through this, we will demonstrate the real importance of making maternity care more sustainable, which is helping improve service user outcomes as well as the environment.
Please contact Hazel Walsh, CSH’s Clinical Transformation Programme Manager for more information.